Presence of gallstones and the risk of cardiovascular diseases: The EPIC-Germany cohort study

Diabetes is the missing link between cardiometabolic index and gallstones: a large cross-sectional study

The cardiometabolic index (CMI), which integrates individual lipid and visceral fat parameters, represents a superior new predictive tool for cardiovascular and metabolic disorders, but its predictive value for gallstones (GS) is unclear. Therefore, the present study used this vacancy to explore the relationship between CMI levels and GS in US adults, assess the mediating role of diabetes mellitus in the pathogenesis of both, and provide new clinical ideas for early prevention and screening of GS in patients with diabetes mellitus. This survey extracted information from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 vintage cycle. Cross-sectional analyses and a variety of statistical techniques were used to analyze the correlation between CMI and GS, including logistic regression, propensity score matching, subject work curves, and restricted cubic spline (RCS). Furthermore, mediation analysis was used to investigate whether and to what extent diabetes mediated the effect of CMI on GS. After analysis of 3,395 participants, a significant positive correlation was observed between elevated CMI levels and increased prevalence of GS In the fully corrected model (Model 4), the prevalence of GS exhibited a 23% increase for every incremental unit rise in logarithmically transformed CM. Mediation analysis showed that diabetes largely mediated the association between CMI and GS, with a mediation ratio of 15.1%. Higher CMI levels are closely linked to a greater occurrence of GS, and diabetes plays a key mediating role in the pathogenesis of both. Addressing dyslipidemia while not neglecting blood glucose levels, and co-management of the two may be a proven way to reduce GS risk.

Gallstones as a predictor of elevated cardiovascular disease risk: A meta-analysis and meta-regression of over 7.4 million participants

INTRODUCTION

Gallstone disease (GD) is a prevalent condition frequently encountered in surgical units worldwide. The objective of this comprehensive systematic review and meta-analysis study was to examine the relationship between gallstones and the risk of cardiovascular diseases (CVDs).

METHODS

To conduct our study, we performed a systematic review and meta-analysis. We gathered relevant studies from reputable databases, including Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase. The quality of the articles was assessed using the Newcastle-Ottawa Scale checklist. To assess heterogeneity among the studies, we utilized statistical tests such as the Chi-square test, I² statistic, and forest plots. Meta-regression analysis considered variables such as the year of the study, study design, sample size, study quality assessment score, geographical region, average age of subjects, and follow-up duration. Additionally, we evaluated publication bias using Begg's and Egger's tests.

RESULTS

Data from 22 studies conducted between 1985 and 2023 were analyzed. The combined number of participants across these studies was 7,496,303. The meta-analysis results revealed that individuals with GD had a higher risk of CVDs (Risk Ratio (RR): 1.29; 95% CI: 1.22-1.36; P <  0.001). Subgroup analysis showed consistent results across good quality studies (RR: 1.20, 95% CI: 11.12-1.28; P <  0.001), moderate quality studies (RR: 1.41, 95% CI: 1.15-1.74; P <  0.001), and low-quality studies (RR: 1.22, 95% CI: 1.15-1.30; P <  0.001). In the meta-regression analysis, none of the variables had a significant relationship with the observed heterogeneity (P-value > 0.10). In a sensitivity analysis, the estimated RR remained consistent, confirming the robustness of the meta-analysis results.

CONCLUSION

Our findings suggest an association between gallstone disease and an increased risk of CVDs. It seems that one of the important factors of this relationship is having common causes for the formation of gallstones and cardiovascular diseases. However, gallstones can be considered an important sign of increased risk of cardiovascular diseases.

The development and evaluation of nine obesity-based indices for gallstones in U.S. adults

OBJECTIVE

Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, RFM, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones.

METHODS

Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the nine indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the nine indicators. In addition, the association between the most predictive indicator and gallstones was investigated with smooth curve fitting, and differences in risk across populations were explored with subgroup analyses.

RESULTS

In total, 3654 participants were involved in the final analysis and 383 (10.48%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, RFM, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs for the highest quartile were 4.13 for RFM, 3.13 for BRI, 2.85 for BMI, 2.86 for WC, 2.45 for LAP, and 1.49 for CMI. The area under the ROC curve for RFM was 0.70. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of RFM and the other metrics was significant ( P < 0.05). Smooth curve fitting suggested a linear positive correlation between RFM and gallstones (LLR > 0.05), especially in women, non-Hispanic White, insufficient physical activity, hypertensive, and diabetic populations.

CONCLUSION

RFM, BRI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that RFM was a better predictor of gallstones.

Association Between Gallstone Disease and Kidney Stone Disease: A Systematic Review and Meta-analysis

Background and aims: Gallstone disease (GSD) and kidney stone disease (KSD) have increased due to lifestyle in recent decades. This systematic review and meta-analysis aimed to investigate the association between these two diseases. Methods: A comprehensive electronic database search was conducted before August 25, 2024. This systematic review and meta-analysis included observational studies. The meta-analysis employed a random-effects model to compute the overall summary estimates of the association between GSD and KSD using risk ratios with 95% confidence intervals (CIs) as the primary measure of the effect size. Heterogeneity was evaluated using chi-square tests, the I² statistic, and forest plots. Publication bias was assessed through Begg’s and Egger’s tests. A P value of less than 0.05 was considered statistically significant, and all analyses were performed using Stata 17 software. Results: The meta-analysis included 9 studies encompassing 982847 participants. The pooled analysis revealed a statistically significant association between GSD and KSD, with a risk of 1.78 (95% CI: 1.572.03, P≤0.001). Begg’s and Egger’s tests demonstrated no significant bias (Begg’s test P=0.835, Egger’s test P=0.812). Variables such as study year, sample size, mean age of participants, mean follow-up, and study quality as determined by the Newcastle-Ottawa Scale (NOS) were examined, but none could significantly impact heterogeneity (P>0.10). Conclusion: This systematic review and meta-analysis provide evidence of a significant association between GSD and KSD. Therefore, further investigation into the underlying mechanisms and potential risk factors is necessary.

Cholecystectomy and risk of cardiovascular disease, all-cause and cause-specific mortality: a systematic review and updated meta-analysis

OBJECTIVE

Questions remain about the association among cholecystectomy, cardiovascular disease, all-cause and cause-specific mortality. We performed a systematic review and meta-analysis to clarify these associations.

METHODS

PubMed, Web of Science, Embase, and Cochrane Library databases were searched up to February 2024. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a DerSimonian-Laird random effects model.

RESULTS

We screened 16,595 articles and included 14 studies. No significant association was found between cholecystectomy and cardiovascular disease (CVD), with RR being 1.03 (95% CI [0.77-1.37], p = 0.848, I 2 = 99.6%), even in results with high heterogenous studies excluded (RR 1.20, 95% CI [0.97-1.49], p = 0.095, I 2 = 77.7%). Same result was proved in its subtype, coronary heart disease (RR 1.06, 95% CI [0.84-1.33], p = 0.633, I2 = 96.6%). Cholecystectomy increased CVD risk compared with healthy controls without gallstones (RR 1.19, 95% CI [1.05-1.35], p = 0.007, I 2 = 83.3%) and lowered CVD risk compared with gallstone carriers (RR 0.62, 95% CI [0.57-0.67], p < 0.001, I 2 = 82.1%). As for mortality, increase in the risk for all-cause (RR 1.17, 95% CI [1.03-1.34], p = 0.020, I 2 = 51.6%) and cardiovascular (RR 1.24, 95% CI [1.06-1.47], p = 0.009, I 2 = 20.7%) mortality, but not for cancer mortality (RR 1.18, 95% CI [0.95-1.47], p = 0.131, I 2 = 0.0%), were observed after cholecystectomy.

CONCLUSION

Cholecystectomy may not be associated with the overall development of CVD, as well as CHD. Cholecystectomized patients showed increased CVD risk compared with healthy controls without gallstones, but decreased CVD risk compared with gallstone patients. Increased risk for all-cause and cardiovascular, but not cancer mortality was observed following cholecystectomy.

Cardiac complications caused by biliary diseases: A review of clinical manifestations, pathogenesis and treatment strategies of cholecardia syndrome

Gallbladder and biliary diseases (GBDs) are one of the most common digestive diseases. The connections between GBDs and several organs other than the liver have gradually surfaced accompanied by the changes in people's diet structure and the continuous improvement of medical diagnosis technology. Among them, cholecardia syndrome that takes the heart as the important target of GBDs complications has been paid close attention. However, there are still no systematic report about its corresponding clinical manifestations and pathogenesis. This review summarized recent reported types of cholecardia syndrome and found that arrhythmia, myocardial injury, acute coronary syndrome and heart failure are common in the general population. Besides, the clinical diagnosis rate of intrahepatic cholestasis of pregnancy (ICP) and Alagille syndrome associated with gene mutation is also increasing. Accordingly, the underlying pathogenesis including abnormal secretion of bile acid, gene mutation, translocation and deletion (JAG1, NOTCH2, ABCG5/8 and CYP7A1), nerve reflex and autonomic neuropathy were further revealed. Finally, the potential treatment measures and clinical medication represented by ursodeoxycholic acid were summarized to provide assistance for clinical diagnosis and treatment.

Association Between Gallstone Disease and Risk of Mortality of Cardiovascular Disease and Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Gallstone disease (GD) is increasing in the world and has various complications.

OBJECTIVE

This study aims to examine the relationship between GD and the risk of mortality from cardiovascular disease (CVD) and cancer using a systematic review and meta-analysis approach.

METHODS

A comprehensive and systematic search was done in various databases, such as Web of Science (WOS), Scopus, MEDLINE/PubMed, Cochrane, and Embase. The search included studies published from 1980 to December 2023. Heterogeneity was assessed using Chi-square, I2, and forest plots, while publication bias was evaluated through Begg's and Egger's tests. All analyses were performed using Stata 15, with statistical significance set at p <0.05.

RESULTS

A pooled analysis of five studies involving 161,671 participants demonstrated that individuals with GD had a significantly higher risk of mortality from CVD (RR 1.29, 95% CI: 1.11-1.50, p <0.001). Importantly, no evidence of publication bias was found based on the results of Begg's test (p =0.806) and Egger's test (p =0.138). Furthermore, the pooled analysis of seven studies, encompassing a total of 562,625 participants, indicated an increased risk of cancer mortality among individuals with GD (RR 1.45, 95% CI: 1.16-1.82, p <0.001). Similarly, no publication bias was detected through Begg's test (p =0.133) and Egger's test (p =0.089).

CONCLUSION

In this study, the evidence of a significant association between GD and an elevated risk of mortality from CVD and canceris provided. These findings suggest that implementing targeted interventions for individuals with gallstone disease could reduce mortality rates among these patients.

Association of gallstone disease with risk of colorectal cancer: a systematic review and meta-analysis of observational studies

BACKGROUND

Numerous studies have assessed the association of gallstones or cholecystectomy (CE) with risk of colorectal cancer (CRC). However, the findings are mixed.

OBJECTIVE

To systematically review and meta-analyse the association between the presence of gallstone disease (GD), or CE and the incidence of CRC. Secondary endpoints were the risk based on type of exposure, study design, tumour subsites and sex.

METHODS

PubMed and EMBASE were searched from September 2020 to May 2021. The protocol was registered on the Open Science Foundation Platform. We identified and classified studies according to their design into prospective cohort, population-based case-control, hospital-based case-control and necropsy studies reporting CRC incidence among individuals with diagnosed GD or after CE (or both). Among 2157 retrieved studies, 65 (3%) met the inclusion criteria. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data were extracted by two independent reviewers. We evaluated the quality of the study according to the Newcastle-Ottawa Scale and only studies with a score of 6 and above were included in the final analyses. We pooled log-transformed odds ratios/risk ratios from the available adjusted models to estimate a summary relative risk (RR) and 95% confidence interval (CI) in a random-effects model. The primary outcome was overall CRC incidence. We also conducted secondary analyses according to sex and CRC subsites (proximal colon, distal colon and rectum). The outcome was measured by RRs with 95% CIs.

RESULTS

The overall association of GD and/or CE with CRC was RR = 1.15 (1.08; 1.24), primarily driven by hospital-based case-control studies [RR = 1.61 (1.29; 2.01)], whereas a more modest association was found in population-based case-control and cohort studies [RR = 1.10 (1.02; 1.19)]. Most hospital-based case-control and necropsy studies reported estimates that were adjusted for age and sex only, leaving room for residual confounding; therefore we restricted to population-based case-control and cohort studies for our subsequent analyses. Similar associations were found for women [RR = 1.21 (1.05; 1.4) and men (RR = 1.24 (1.06; 1.44)]. When assessed by CRC subsites, GD and CE were primarily associated with higher risk of proximal colon cancer [RR = 1.16 (1.07; 1.26)] but not distal colon cancer [RR = 0.99 (0.96; 1.03)] or rectal cancer [RR = 0.94 (0.89; 1.00)].

CONCLUSIONS

Gallstones are associated with a modestly increased risk of colon cancer, primarily in the proximal colon.

Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions

BACKGROUND

More recent data are required relating to disease risk for use of various smoked products and of other products containing nicotine. Earlier we published meta-analyses of recent results for chronic obstructive pulmonary disease and lung cancer on the relative risk (RR) of current compared to never product use for cigarettes, cigars and pipes based on evidence from North America, Europe and Japan. We now report corresponding up-to-date evidence for acute myocardial infarction (AMI), ischaemic heart disease (IHD) and stroke.

AIM

To estimate, using recent data, AMI, IHD and stroke RRs by region for current smoking of cigarettes, cigars and pipes.

METHODS

Publications in English from 2015 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of AMI, IHD or stroke for one or more of the three products. The studies should involve at least 100 cases of stroke or cardiovascular disease (CVD), not be restricted to populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. A literature search was conducted on MEDLINE, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, we entered the most recent available data on current smoking of each product, as well as the characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis for stroke and, in the case of CVD, separately for IHD and AMI. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. A more limited assessment of variation in risk by daily number of cigarettes smoked was also conducted. Results were compared with those from previous meta-analyses published since 2000.

RESULTS

Current cigarette smoking: Ten studies gave a random-effects RR for AMI of 2.72 [95% confidence interval (CI): 2.40-3.08], derived from 13 estimates between 1.47 and 4.72. Twenty-three studies gave an IHD RR of 2.01 (95%CI: 1.84-2.21), using 28 estimates between 0.81 and 4.30. Thirty-one studies gave a stroke RR of 1.62 (95%CI: 1.48-1.77), using 37 estimates from 0.66 to 2.91. Though heterogeneous, only two of the overall 78 RRs were below 1.0, 71 significantly (P < 0.05) exceeding 1.0. The heterogeneity was only partly explicable by the factors studied. Estimates were generally higher for females and for later-starting studies. They were significantly higher for North America than Europe for AMI, but not the other diseases. For stroke, the only endpoint with multiple Japanese studies, RRs were lower there than for Western studies. Adjustment for multiple factors tended to increase RRs. Our RR estimates and the variations by sex and region are consistent with earlier meta-analyses. RRs generally increased with amount smoked. Current cigar and pipe smoking: No AMI data were available. One North American study reported reduced IHD risk for non-exclusive cigar or pipe smoking, but considered few cases. Two North American studies found no increased stroke risk with exclusive cigar smoking, one reporting reduced risk for exclusive pipe smoking (RR 0.24, 95%CI: 0.06-0.91). The cigar results agree with an earlier review showing no clear risk increase for IHD or stroke.

CONCLUSION

Current cigarette smoking increases risk of AMI, IHD and stroke, RRs being 2.72, 2.01 and 1.62. The stroke risk is lower in Japan, no increase was seen for cigars/pipes.

Impact of gallstone disease on the risk of stroke and coronary artery disease: evidence from prospective observational studies and genetic analyses

BACKGROUND

Despite epidemiological evidence associating gallstone disease (GSD) with cardiovascular disease (CVD), a dilemma remains on the role of cholecystectomy in modifying the risk of CVD. We aimed to characterize the phenotypic and genetic relationships between GSD and two CVD events - stroke and coronary artery disease (CAD).

METHODS

We first performed a meta-analysis of cohort studies to quantify an overall phenotypic association between GSD and CVD. We then investigated the genetic relationship leveraging the largest genome-wide genetic summary statistics. We finally examined the phenotypic association using the comprehensive data from UK Biobank (UKB).

RESULTS

An overall significant effect of GSD on CVD was found in meta-analysis (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.19-1.34). Genetically, a positive shared genetic basis was observed for GSD with stroke ([Formula: see text]=0.16, P = 6.00 × 10-4) and CAD ([Formula: see text]=0.27, P = 2.27 × 10-15), corroborated by local signals. The shared genetic architecture was largely explained by the multiple pleiotropic loci identified in cross-phenotype association study and the shared gene-tissue pairs detected by transcriptome-wide association study, but not a causal relationship (GSD to CVD) examined through Mendelian randomization (MR) (GSD-stroke: odds ratio [OR] = 1.00, 95%CI = 0.97-1.03; GSD-CAD: OR = 1.01, 95%CI = 0.98-1.04). After a careful adjustment of confounders or considering lag time using UKB data, no significant phenotypic effect of GSD on CVD was detected (GSD-stroke: hazard ratio [HR] = 0.95, 95%CI = 0.83-1.09; GSD-CAD: HR = 0.98, 95%CI = 0.91-1.06), further supporting MR findings.

CONCLUSIONS

Our work demonstrates a phenotypic and genetic relationship between GSD and CVD, highlighting a shared biological mechanism rather than a direct causal effect. These findings may provide insight into clinical and public health applications.

Gallstone Disease and Its Association With Nonalcoholic Fatty Liver Disease, All-Cause and Cause-Specific Mortality

BACKGROUND & AIMS

Presence of gallstone disease may influence outcomes in patients with nonalcoholic fatty liver disease (NAFLD). We studied the impact of gallstone disease on mortality in individuals with and without NAFLD.

METHODS

Prospective cohort study used the Third National Health and Nutrition Examination Survey (1988-1994) with mortality data through 2015. Gallstone disease was defined as ultrasonographic evidence of gallstones or absence of the gallbladder (prior cholecystectomy). NAFLD was defined using standardized ultrasonographic criteria.

RESULTS

Gallstone disease and cholecystectomy were independently associated with NAFLD (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.43-2.15 for gallstone disease and OR, 2.77; 95% CI, 2.01-3.83 for cholecystectomy compared with no gallstone disease). During the median follow-up of 23 years, gallstone disease was associated with a higher risk of all-cause mortality (hazard ratio [HR], 1.19; 95% CI, 1.05-1.37) and cause-specific mortality. Gallstone disease was associated with a higher risk of all-cause mortality in non-NAFLD sub-cohort (HR, 1.42; 95% CI, 1.23-1.64) but not in NAFLD (HR, 1.03; 95% CI, 0.87-1.22). Gallstone disease was associated with a higher risk of cardiovascular-related (HR, 1.40; 95% CI, 1.10-1.78) and cancer-related (HR, 1.71; 95% CI, 1.18-2.48) mortality in non-NAFLD sub-cohort. Gallstone disease was associated with increased cardiovascular mortality (HR, 1.36; 95% CI, 1.05-1.77) in NAFLD.

CONCLUSIONS

Gallstone disease is an independent risk factor for NAFLD, but gallstone disease is not associated with all-cause mortality in individuals with NAFLD. Screening for gallstone disease in individuals at risk for developing NAFLD may help with risk stratification for all-cause mortality related to gallstone disease.

Renal Stones and Gallstones Correlated with the Ten-Year Risk Estimation of Atherosclerotic Cardiovascular Disease Based on the Pooled Cohort Risk Assessment of Males Aged 40–79

Background: The risk of developing atherosclerotic cardiovascular disease (ASCVD) is unknown for subjects with both gallstones and renal stones, nor is it known whether there is a difference in the risk between gallstones and renal stones. This study aimed to determine the risk relationship between gallstones and renal stones and the risk of ASCVD in a male population. Methods: We recruited 6371 eligible males aged 40 to 79 years old who did not have a documented ASCVD history. The ten-year ASCVD risk was calculated using the pooled cohort equations developed by the American College of Cardiology (ACC) and the American Heart Association (AHA). The ASCVD risk score was classified as a low risk (<7.5%), an intermediate risk (7.5% to 19.9%), or a high risk (≥20%). The diagnosis of gallstones and renal stones was established based on the results of abdominal sonography. Results: Both gallstones and renal stones were associated with a high level of intermediate risk (OR = 3.21, 95% CI = 1.89–5.49, p < 0.001) and high risk (OR = 3.01, 95% CI = 1.48–6.12, p < 0.001), compared to individuals with no stones at all, after adjusting for the effects of other clinical variables. The possession of gallstones was associated with a higher level of high ASCVD risk (OR = 1.84, 95% CI = 1.31–2.59, p < 0.05) than that of renal stones. Conclusions: The ASCVD risk was higher for males with gallstones than for those with renal stones. Men with both types of stones faced a risk of ASCVD that was three times higher than that of men without stones.

Gallbladder disease is associated with the risk of cardiovascular disease among Uyghurs in Xinjiang: a prospective cohort study

BACKGROUND

Gallbladder disease (GBD) can increase the risk of cardiovascular disease (CVD). However, GBD has rarely been reported in the less developed, rural areas of Xinjiang. This study aimed to determine the prevalence of GBD and incidence of CVD in a prospective cohort study in rural Xinjiang. Moreover, the study aimed to explore the association between GBD and CVD within this cohort.

METHODS

The study cohort included 11,444 Uyghur adults in Xinjiang, 3^rd division, from the 51st Mission. Study groups were classified according to whether GBD was present or absent at baseline. The occurrence of CVD was the end event. Demographic, anthropometric, and biochemical data were recorded, and the incidence of CVD in the GBD and non-GBD groups analysed. Cox proportional hazards regression models were used to assess the association between GBD and CVD and factors associated with their incidence. Several subgroup analyses were performed to assess CVD incidence in different subgroups. The interaction between GBD and cardiometabolic risk factors, and subsequent risk of developing CVD, was evaluated.

RESULTS

Prevalence of GBD in the study cohort was 10.29%. After a median follow-up of 4.92 years, the cumulative incidence of CVD in the study cohort was 10.49%, 8.43% in males and 12.65% in females. CVD incidence was higher in the GBD group (34.04% vs. 7.78%, HR = 4.96, 95% CI: 4.40-5.59). After multivariate adjustment, the risk of CVD remained higher in the GBD group (HR = 2.89, 95% CI: 2.54-3.29). Subgroup analyses showed male sex, smoking, alcohol consumption, lack of exercise, and abnormal renal function were all associated with increased risk of CVD. Moreover, the risk of CVD was markedly higher in GBD combined with cardiometabolic risk factors (hypertension, T2DM, dyslipidaemia, overweight, and abdominal obesity), than in cardiometabolic risk factors alone and this was higher in the GBD group than in the non-GBD group regardless of whether cardiometabolic risk factors were combined.

CONCLUSION

GBD is an important independent risk factor for CVD development. Awareness of these associations will raise concerns among clinicians about the risk of cardiovascular disease in patients with GBD.

The increasing incidence and high body mass index-related burden of gallbladder and biliary diseases-A results from global burden of disease study 2019

BACKGROUND

Gallbladder and biliary diseases are common gastrointestinal conditions associated with huge socioeconomic costs and are considered risk factors for cardiovascular diseases and digestive system cancers. The prevalence and incidence of gallbladder and biliary diseases have not received enough attention from 1990 to 2019. Several non-communicable diseases were associated with the incidence of gallbladder and biliary diseases. It is necessary to clarify the change in the incidence and disability burden of gallbladder and biliary diseases worldwide.

METHODS

Data on high body mass index (BMI)-related disease burden and incidence, years of life lost prematurely, and years lived with disability (YLDs) due to gallbladder and biliary diseases were obtained from the Global Burden of Disease 2019. The estimated annual percentage change was calculated to qualify the gallbladder and biliary disease burden change.

RESULTS

The global age-standardized incidence rate has increased from 585.35 per 100,000 (95% UI: 506.05-679.86) in 1990 to 634.32 per 100,000 (95% UI: 540.21-742.93) in 2019. And the increase in incidence was positively correlated with rising high BMI-related summary exposure value. The high BMI-related YLDs of gallbladder and biliary diseases have increased worldwide over time. Globally, the 25-49 age group suffered a rapid rise in incidence and high BMI attributable to the YLDs rate of gallbladder and biliary diseases.

CONCLUSION

The global incidence and high BMI-related YLDs of gallbladder and biliary diseases remain prominent to increase over the past 30 years. Notably, the incidence and high BMI-related YLDs among people aged 25-49 years have rapidly increased over time. Therefore, high BMI should be emphasized in strategic priorities for controlling gallbladder and biliary diseases.

Gallstone disease and the risk of cardiac mortality in patients with acute coronary syndrome

Background

Gallstone disease is a common gastrointestinal disorder, which has previously been reported to be associated with the incidence of cardiovascular disease. We aimed to investigate the association between gallstone disease and long-term outcomes in patients with acute coronary syndrome (ACS).

Materials and methods

A total of consecutive 13,975 ACS patients were included in this analysis. Gallstone disease in our study included both gallstones and cholecystectomy. The primary endpoint was cardiac mortality. The secondary outcome was all-cause mortality. Relative risks were estimated using Cox proportional hazards regression.

Results

During a median follow-up period of 2.96 years, 518 (4.2%) patients without gallstone disease and 62 (3.6%) patients in those with gallstone disease suffered cardiac death. After multivariable adjustment for established risk factors, subjects with gallstone disease had decreased risks of both cardiac mortality and all-cause mortality [hazard rate ratios (HR) = 0.72, 95% CI: 0.55-0.95 and HR = 0.75, 95% CI: 0.62-0.90, respectively]. In patients with performed cholecystectomy, the associations between gallstones and risks for cardiac mortality and all-cause mortality turned out to be non-significant. HRs varied across subgroups depending on the presence of selected established risk factors.

Conclusion

Presence of gallstone disease was associated with a significantly decreased risk of follow-up mortality in patients with ACS.

Cholecystectomy reduces the risk of myocardial and cerebral infarction in patients with gallstone-related infection

We compared the risk of myocardial infarction (MI) or cerebral infarction (CI) in patients with or without-gallstone-related infection (GSI) and change in the risk following cholecystectomy. GSI (n = 84,467) and non-GSI (n = 406,800) patients with age- and sex-matched controls (n = 4,912,670) were identified from Korean population based data. The adjusted hazard ratios (aHRs) of MI or CI were analyzed in both groups treated with or without cholecystectomy. Subgroup analysis was performed for both sexes and different ages. The risk of MI or CI was higher in the GSI group than in the non-GSI group (aHR for MI; 1.32 vs. 1.07, aHR for CI; 1.24 vs. 1.06, respectively). The risk reduction rate of MI following cholecystectomy was 11.4% in the GSI group, whereas it was 0% in the non-GSI group. The risk of CI after cholecystectomy was more reduced in the GSI group than in the non-GSI group (16.1% and 4.7%, respectively). The original risk of MI or CI in patients with gallstones and risk reduction rates following cholecystectomy were higher in females and younger patients than in males and older patients. Increased risk of MI or CI and greater risk reduction following cholecystectomy were seen in patients with GSI.

Gallstone Disease and Bacterial Metabolic Performance of Gut Microbiota in Middle-Aged and Older Patients

Background

Gallstone disease (GSD) is more commonly presented in aged people.

Purpose

The purpose of the study was to explore the insights of metabolic performance of bacterial species from gut microbiota as well as the clinical background in middle-aged and elderly patients with GSD.

Patients and Methods

This is an observational study concerning 120 research participants. Of those, 90 patients with symptomatic GSD addressed for cholecystectomy, average age 59.83 ± 15.32 years: 45 with cholesterol rich gallstones (CGSs), 45 with pigment gallstones (PGSs) and 30 healthy controls joined this observational study. Clinical examination, lab work-ups, upper and lower digestive video-endoscopies, abdominal ultrasound/CT and gallbladder motility assessment by Dodd’s method were performed. Overall stool dysbiosis (DB) was assessed as 1 = minor, 2 = mild, 3 = severe, species being identified by matrix-assisted laser desorption ionization method. Stool samples from dysbiotic patients were analyzed by a next generation sequencing method with operational taxonomic unit identification.

Results

Patients with GSD presented with a significant high range of overall gut DB (p < 0.0001) when compared with controls. Those with CGSs compared with those having PGSs displayed significant clinical differences related to elderly age, lifestyle and diet particularities, obesity, dyslipidemia, nonalcoholic fatty liver disease, hypertension, type 2 diabetes mellitus or impaired glucose tolerance, as well as motility disturbances of gallbladder with a decrease of the ejection fraction. Significant increase of overall DB range and alterations of several functional bacterial species with a decrease of butyrate, lactate, acetate/propionate and methane producers, mucin degrading bacteria, biodiversity index of microbiota, as well as an increase of lipopolysaccharide positive bacteria were significantly present in patients with CGSs.

Conclusion

Middle-aged and elderly patients with GSD and a clinical background characterized by particular lifestyle, metabolic and gallbladder motility issues displayed significant modifications of biodiversity, overall gut DB and alterations of several functional bacterial species, with a decrease of their metabolic performance.

Blood lipid metabolism and the risk of gallstone disease: a multi-center study and meta-analysis

Background

Gallstone disease (GSD) is a common and costly biliary disorder. Multiple studies have investigated the associations between blood lipid metabolism and GSD risk; however, the results are inconsistent. This research aimed to comprehensively evaluate the relationships among serum total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and GSD risk.

Methods

Firstly, a multi-center cross-sectional study was carried out. Subjects who participated in the health examination in three hospitals between January 2015 and May 2020 were recruited. Multivariable logistic regression was used to investigate blood lipid metabolism associated with GSD risk. Then, a meta-analysis was performed to verify the associations further. Medline and Embase databases were systematically searched before June 10, 2021. The DerSimonian and Laird random-effect model was utilized when the heterogeneity was high; otherwise, fixed-effect model was adopted.

Results

There were 548,934 eligible participants included in the multi-center study, and 45,392 of them were diagnosed with GSD. The results demonstrated that total cholesterol and HDL cholesterol were negatively associated with GSD risk in both high vs. low model and per mmol/L increase model, while triglyceride was positively associated with GSD risk in the per unit increase model. In the meta-analysis, 104 studies with approximately 3 million participants were finally included. The results verified that HDL cholesterol [odds ratio (OR) = 0.636, P = 5.97 × 10^− 16 in high vs low model; OR = 0.974, P = 6.07 × 10^− 05 in per unit model] and triglyceride (OR = 1.192, P = 3.47 × 10^− 05 in high vs. low model; OR = 1.011, P = 5.12 × 10^− 05 in per unit model) were related to GSD risk in the two models.

Conclusions

The findings indicated that low HDL cholesterol levels and high triglyceride levels were risk factors for GSD. This study provides a basis for identifying the population at high risk for GSD and implementing tertiary prevention strategies for GSD, thus contributing to GSD prevention as well as disease burden relief.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-022-01635-9.

Gallstone Disease and Risk of Conventional Adenomas and Serrated Polyps: A Prospective Study

BACKGROUND

Gallstone disease has been associated with colorectal cancer and some form of polyps, although the findings are inconclusive. It remains unknown whether gallstone disease influences the initiation of colorectal cancer.

METHODS

We prospectively assessed the association of gallstone disease with risk of colorectal cancer precursors, including conventional adenomas and serrated polyps, in the Nurses' Health Study (1992-2012), the Nurses' Health Study II (1991-2011), and the Health Professionals Follow-up Study (1992-2012). Gallstone diseases were assessed using biennial follow-up questionnaires. Self-reported polyp diagnosis was confirmed by review of medical records. Logistic regression models were used to calculate the ORs with adjustment for smoking and other potential confounders.

RESULTS

Among participants who had undergone a total of 323,832 endoscopies, 16.5% had gallstone disease and 11.3% received cholecystectomy. We documented 1,724, 1,212, and 1,943 cases of conventional adenomas and 1,470, 1,090, and 1,643 serrated polyps in patients with gallstones, cholecystectomy, and either of them, respectively. The OR for adenomas was 1.00 [95% confidence interval (CI): 0.95-1.06] for gallstones, 0.99 (95% CI: 0.93-1.06) for cholecystectomy, and 1.00 (95% CI: 0.95-1.05) for either exposure. The corresponding ORs for serrated polyps were 0.98 (95% CI: 0.92-1.04), 0.99 (95% CI: 0.93-1.06), and 0.97(95% CI: 0.92-1.03), respectively.

CONCLUSIONS

Gallstone disease is not associated with colorectal polyps.

IMPACT

Patients with gallstones appear to have similar risk of colorectal polyps compared with those without and may therefore follow average-risk colorectal cancer screening guidelines.

Reduced Risk of Atrial Fibrillation Following Cholecystectomy: A Nationwide Population-Based Study

Background: Gallstone disease (GD) is associated with a high risk of cardiovascular disease. However, it is unknown whether GD contributes to atrial fibrillation (AF). We aimed to investigate the association between GD and AF. Methods: We performed a population-based cohort study using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. A GD cohort of 230,076 patients was compared with a control cohort consisting of an equal number of patients matched for age, sex, cardiovascular and gastrointestinal comorbidities. Results: In total, 5,992 (49.8/10,000 person-years) patients with GD and 5,804 (44.5/10,000 person-years) controls developed AF. GD increased AF risk with a hazard ratio (HR) of 1.20 [95% confidence interval (CI), 1.16-1.25]. In patients with GD but without cholecystectomy, the HR of AF reached 1.57 (95% CI = 1.50-1.63). After cholecystectomy, the HR of AF significantly decreased to 0.85 (95% CI = 0.81-0.90). Among the three age groups with GD (<45, 45-64, and ≥65 years), the adjusted HRs of AF were 1.59 (95% CI = 1.08-2.33), 1.31 (95% CI = 1.18-1.45), and 1.18 (95% CI = 1.13-1.22), respectively. Compared with patients with a CHA2DS2-VASc score equal to 0, the HRs of AF risk among total cohort patients and a score equal to 1, 2, 3, and ≥ 4 were 1.28 (95% CI = 1.15-1.43), 2.26 (95% CI = 2.00-2.56), 3.81 (95% CI = 3.35-4.34), and 5.09 (95% CI = 4.42-5.87), respectively. Conclusion: This population-based longitudinal follow-up study showed that patients with GD had an increased AF risk. Moreover, cholecystectomy was related to reduced AF risk. Cardiovascular checkups may be necessary for patients with GD, especially those who are young and have other typical risk factors.

Risk of Heart Disease after Cholecystectomy: A Nationwide Population-Based Cohort Study in South Korea

The aim of the study is to evaluate the risk of heart disease in individuals who underwent cholecystectomy. This was a retrospective cohort study using the National Health Insurance Service database of South Korea. A total of 146,928 patients who underwent cholecystectomy and 268,502 age- and sex-matched controls were compared. Multivariate Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for heart disease after cholecystectomy. In results, a previous history of cholecystectomy increased the risk of heart disease (congestive heart failure [CHF], myocardial infarction [MI], atrial fibrillation [AF]) (adjusted HR [aHR]: 1.40, 95% CI: [1.36–1.44]). The increased risk was particularly seen for CHF (1.22 [1.16–1.29]) but not for MI and AF (p > 0.05). In the subgroup analyses, cholecystectomy was associated with an increased risk of MI in patients aged <65 years (1.49 [1.16–1.92] and 1.18 [1.05–1.35] in patients aged 40–49 and 50–64 years, respectively), but not in those aged ≥ 65 years (0.932 [0.838–1.037]). Moreover, the risk of MI was increased in patients without diabetes mellitus (DM) (1.16 [1.06–1.27]); however, it was decreased in patients with DM (0.83 [0.72–0.97]). In contrast, cholecystectomy did not modify the risk of AF in the subgroup analyses (all p > 0.05). In conclusion, a history of cholecystectomy is associated with an increased risk of CHF. Cholecystectomy may increase the risk of MI in the younger population without DM. These findings suggest that the alteration of bile metabolism and homeostasis might be potentially associated with the development of some heart diseases.

The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones

Objectives: To investigate the effect of cholecystectomy on the subsequent risk of acute myocardial infarction (AMI) in patients with gallbladder stones (GBS).Methods: We used the Taiwan National Health Insurance Research Database (NHIRD) for hospitalization to conduct a retrospective nationwide population-based cohort study. The study cohort consisted of a total of 122,421 patients aged ≥20 years with cholecystectomy for GBS between 2000 and 2010. The control cohort consisted of the GBS patients without cholecystectomy and they were randomly selected by propensity score matching with the study cohort at a 1:1 ratio according to age, sex, occupation category, urbanization level, comorbidities, and year of the index date for cholecystectomy. We measured the incidence of AMI for both cohorts.Results: The cumulative incidence of AMI was lower in GB patients with cholecystectomy than that in those without cholecystectomy (2.26 vs 3.28 per 1000 person-years, adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.61-0.69). Compared to those without cholecystectomy, the risk of developing AMI after cholecystectomy was 0.69 (95% CI = 0.63-0.76) for the first year, 0.69 (95% CI = 0.63-0.77) for 2-5 years, and 0.59 (95% CI = 0.53-0.66) for ≥5 years, respectively.Conclusions: Our findings indicate cholecystectomy ameliorates the risk of AMI in patients with GBS, and the protective effect tends to increase with incremental duration of follow-up. However, it needs more studies to ascertain the protective mechanisms of cholecystectomy against AMI.

The interplay between gastrointestinal and cardiovascular diseases: a narrative review focusing on the clinical perspective

Both cardiovascular and gastrointestinal disorders represent considerable health burden on community clinics and hospitals with overwhelming economic cost. An overlap in the occurrence of these disorders is encountered in daily practice. Both affect each other in bidirectional manner through several mechanisms including altered hemodynamics, systemic inflammation, bacterial overgrowth and interactions and adverse effects of medications. In addition, to the known overlap in the symptoms occurrence of upper gastrointestinal tract diseases and cardiovascular diseases (CVDs). Awareness of this interplay and its clinical manifestations optimizes patient management, and could prevent catastrophic consequences and even save lives. In this review, we highlighted the clinical aspects of this bidirectional association between gastrointestinal and CVDs aiming to shed light on this topic and improve patients' care.

A healthy lifestyle pattern and the risk of symptomatic gallstone disease: results from 2 prospective cohort studies

BACKGROUND

Symptomatic gallstones cause high financial and disease burden for public health systems. The combined role of diet and other lifestyle factors has not been studied so far.

OBJECTIVES

We aimed to investigate the association between an a priori defined healthy lifestyle score (HLS, including healthy diet, moderate alcohol and regular coffee intakes, never smoking, physical activity, and normal weight) and the risk of symptomatic gallstone disease, and to estimate the proportion of cases potentially preventable by lifestyle modification.

METHODS

We followed 60,768 women from the Nurses' Health Study (NHS) and 40,744 men from the Health Professionals Follow-up Study (HPFS), both ongoing prospective cohort studies, from baseline (1986) until 2012. Symptomatic gallstone disease was self-reported and validated by review of medical records. The association between the HLS and the risk of symptomatic gallstone disease was investigated using Cox proportional hazards regression.

RESULTS

During 1,156,079 and 769,287 person-years of follow-up, respectively, 6946 women and 2513 men reported symptomatic gallstone disease. Comparing 6 with 0 points of the HLS, the multivariable HR of symptomatic gallstone disease was 0.26 (95% CI: 0.15, 0.45) for women, and 0.17 (95% CI: 0.07, 0.43) for men. For individual lifestyle factors, multivariable and mutually adjusted partial population attributable risks (women and men) were 33% and 23% for BMI <25 kg/m2, 10% and 18% for ≥2 cups of coffee per day, 13% and 7% for moderate alcohol intake, 8% and 11% for a high Alternate Healthy Eating Index 2010, 9% and 5% for being physically active, and 1% and 5% for never smoking. The full population attributable risk percentage for all factors combined was 62% and 74%, respectively.

CONCLUSIONS

Findings from these large prospective studies indicate that adopting a healthy lifestyle, especially maintaining a healthy weight, can help to prevent a considerable proportion of symptomatic gallstone diseases.

Reduced risk of stroke following cholecystectomy: A nationwide population-based study

BACKGROUND AND AIM

Gallstones and stroke are common diseases worldwide. The relationship between gallstones and stroke has been documented in the literature. In this work, to characterize the risk of stroke among gallstone patients with and without cholecystectomy, we investigated the effects of cholecystectomy in a nationwide population-based retrospective cohort study.

METHODS

Data were obtained from Taiwan's National Health Insurance Research Database. The study comprised 155 356 gallstone patients divided into two groups: those with and without cholecystectomy.

RESULTS

During the study period (2000-2012), 19 096 (17.8/1000 person-years) gallstone patients without cholecystectomy and 11 913 (10.6/1000 person-years) gallstone patients with cholecystectomy had a stroke. Following gallstone removal, the patients exhibited a significant decrease in the risk of overall stroke (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.59-0.61), ischemic stroke (HR = 0.59, 95% CI = 0.58-0.61), and hemorrhagic stroke (HR = 0.56, 95% CI = 0.53-0.59). Asymptomatic and symptomatic gallstone patients had lower overall stroke risk after cholecystectomy (HR = 0.64, 95% CI = 0.62-0.67 and HR = 0.57, 95% CI = 0.56-0.59) than did asymptomatic gallstone patients without cholecystectomy.

CONCLUSIONS

This population-based cohort study demonstrated that cholecystectomy is related to reduce the risk of overall stroke, ischemic stroke, and hemorrhagic stroke. Preventive measures for stroke may be considered for gallstone patients, particularly those presenting risk factor(s) for stroke.

Gallstone Disease and the Risk of Cardiovascular Disease

Gallstone disease (GD) is one of the most common presentations to surgical units worldwide and shares several risk factors with cardiovascular disease (CVD). CVD remains the most common cause of death worldwide and results in considerable economic burden. Recent observational studies have demonstrated an association between GD and CVD with some studies demonstrating a stronger association with cholecystectomy. We present the findings of a meta-analysis assessing the relationship between GD and CVD. A total of fourteen cohort studies with over 1.2 million participants were included. The pooled hazard ratio (HR, 95% confidence interval [CI]) for association with GD from a random-effects model is 1.23 (95%CI: 1.16-1.30) for fatal and non-fatal CVD events. The association was present in females and males. Three studies report the relationship between cholecystectomy and CVD with a pooled HR of 1.41 (95%CI: 1.21-1.64) which compares to a HR of 1.30 (95%CI: 1.07-1.58) when cholecystectomy is excluded although confounding may influence this result. Our meta-analysis demonstrates a significant relationship between GD and CVD events which is present in both sexes. Further research is needed to assess the influence of cholecystectomy on this association.

Association between gallstone and cardio-cerebrovascular disease: Systematic review and meta-analysis

Increasing evidence connects gallstone disease (GD) to cardio-cerebrovascular disease (CVD). The aim of the present systematic review and meta-analysis was to determine whether and to what extent an association between GD and CVD existed. PubMed, EMBASE and the Cochrane Library were systemically searched up to March 3rd, 2018. A total of 10 studies (1,272,177 participants; 13,833 records; 5 prospective cohorts and 5 retrospective cohorts) were included. It was demonstrated that GD was associated with an increased risk of incidence [hazard ratio=1.24, 95% (CI) confidence interval: 1.17–1.31] and prevalence (unadjusted odds ratio=1.23, 95% CI: 1.21–1.25) of CVD. In conclusion, the presence of GD was associated with an increased risk of CVD incidence and prevalence. The association may be influenced by age and sex. These findings suggest that individuals identified with cardio-cerebrovascular disease should be evaluated for GD.

Diet-quality scores and the risk of symptomatic gallstone disease: a prospective cohort study of male US health professionals

OBJECTIVE

To investigate the association between three diet-quality scores corresponding to adherence to healthy dietary patterns [alternate Mediterranean (aMed), Alternate Healthy Eating Index (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH)] and the risk of symptomatic gallstone disease.

METHODS

The study comprised 43 635 men of the Health Professionals Follow-up Study-an ongoing prospective cohort study of US health professionals. Participants were free of symptomatic gallstone disease and diabetes and provided dietary information every 4 years from 1986 (baseline) until 2012. The aMed, AHEI-2010 and DASH scores were generated and associated with the risk of symptomatic gallstone disease using Cox proportional hazards regression.

RESULTS

During 716 904 person-years of follow-up, 2382 incident cases of symptomatic gallstone disease were identified. All three scores were inversely associated with risk of symptomatic gallstone disease after adjustment for potential confounders including age, smoking, physical activity, energy and coffee intake [hazard ratios (HRs) and 95% confidence intervals (CIs)] comparing the highest with the lowest quintiles: aMed: 0.66 (0.57-0.77), AHEI-2010: 0.64 (0.56-0.74) and DASH: 0.66 (0.58-0.76)]. Findings were similar after additional adjustment for body mass index and after inclusion of asymptomatic cases. Associations were stronger when analysis was restricted to cases who had undergone cholecystectomy.

CONCLUSIONS

In this prospective cohort of male US health professionals, higher adherence to the aMed, AHEI-2010 and DASH diets was associated with lower risk of symptomatic gallstone disease. Dietary recommendations focusing on high-quality diets targeting symptomatic gallstone disease may lower the incidence of this prevalent disease.

The relation between gallstone disease and cardiovascular disease

Gallstone disease (GD) is a common digestive disorder that shares many risk factors with cardiovascular disease (CVD). CVD is an important public health issue that encompasses a large percentage of overall mortality. Several recent studies have suggested an association between GD and CVD, while others have not. In this report, we present a meta-analysis of cohort studies to assess the association between GD and CVD. We included eight studies published from 1980 to 2017, including nearly one million participants. The pooled relative risk (RR, 95% confidence interval [CI]) from the random-effects model associates with GD is 1.23 (95% CI: 1.17-1.30) for fatal and nonfatal CVD events. The pooled RR from the random-effects model of CVD events in female patients with GD is 1.24 (95% CI: 1.16-1.32). In male GD patients, the pooled RR from the random-effects model for CVD is 1.18 (95% CI: 1.06-1.31). Our meta-analysis demonstrates a substantially increased risk of fatal and nonfatal CVD events among patients with a medical history of GD. We suggest that interested investigators should further pursue the subject. In addition, both male and female patients with GD have a risk of CVD, and women have a higher risk than men.

Gallstone disease associated with increased risk of arterial stiffness in a Taiwanese population

Arterial stiffness has similar risk factors to gallstone disease (GSD). However, there are few studies on the association between arterial stiffness and GSD. The aim of this study was to determine the relationship between arterial stiffness and GSD in a Taiwanese population. We enroled 6211 subjects from a health examination centre after excluding those who received medications for diabetes, hypertension and hyperlipidemia or had a history of cardiovascular disease, cerebrovascular disease, cancer, cholecystectomy or ankle-brachial index of ⩽ 0.9 or⩾1.3. Increased arterial stiffness was defined as right brachial-ankle pulse wave velocity (baPWV) ⩾1400 cm s^-1. The diagnosis of GSD was based on ultrasonographic findings. The prevalence of increased arterial stiffness was 47.2 and 31.9 % in subjects with and without GSD (P<0.001). A multiple linear regression analysis revealed that GSD, age, systolic blood pressure, fasting plasma glucose and current smoking were positively associated with baPWV, whereas male gender, BMI, habitual exercise and HDL-C were negatively related to baPWV after adjusting for other clinical variables. In conclusion, subjects with GSD are associated with an increased risk of arterial stiffness.

Absence of association between gallstone and coronary artery calcification

BACKGROUND AND AIMS

Gallstone has been suggested to be associated with cardiovascular disease (CVD). Coronary artery calcification (CAC) is an excellent value to predict future CVD. The aim of this study was to evaluate the association between gallstone and CAC.

METHODS

Data were analyzed from an occupational cohort of 46,893 subjects (37,557 men and 9336 women) between 2011 and 2014. Participants with cancer or CVD histories or missing data at baseline were excluded from the study. Gallstone was diagnosed by ultrasound-documentation. Multivariate logistic analysis was conducted to examine the relationship between gallstone and CAC.

RESULTS

The total population who had gallstone was 1426 (3.1%). In multivariate analysis, odds ratios (OR) for gallstone were not different according to CAC score groups in men and women. In addition, gallstone was not associated with higher OR for CAC in men and women.

CONCLUSIONS

Gallstone was not associated with CAC in both Korean men and women.

Gallstones and Risk of Coronary Heart Disease: Prospective Analysis of 270 000 Men and Women From 3 US Cohorts and Meta-Analysis

OBJECTIVE

Gallstone disease has been related to cardiovascular risk factors; however, whether presence of gallstones predicts coronary heart disease (CHD) is not well established.

APPROACH AND RESULTS

We followed up 269 142 participants who were free of cancer and cardiovascular disease at baseline from 3 US cohorts: the Nurses' Health Study (112 520 women; 1980-2010), Nurses' Health Study II (112 919 women; 1989-2011), and the Health Professionals Follow-up Study (43 703 men; 1986-2010) and documented 21 265 incident CHD cases. After adjustment for potential confounders, the hazard ratio for the participants with a history of gallstone disease compared with those without was 1.15 (95% confidence interval, 1.10-1.21) in Nurses' Health Study, 1.33 (95% confidence interval, 1.17-1.51) in Nurses' Health Study II, and 1.11 (95% confidence interval, 1.04-1.20) in Health Professionals Follow-up Study. The associations seemed to be stronger in individuals who were not obese, not diabetic, or were normotensive, compared with their counterparts. We identified 4 published prospective studies by searching PUBMED and EMBASE up to October 2015, coupled with our 3 cohorts, involving 842 553 participants and 51 123 incident CHD cases. The results from meta-analysis revealed that a history of gallstone disease was associated with a 23% (15%-33%) increased CHD risk.

CONCLUSION

Our findings support that a history of gallstone disease is associated with increased CHD risk, independently of traditional risk factors.

Gallstones: new insights into an old story

Gallstones, particularly cholesterol gallstones, are common in Western populations and may cause symptoms such as biliary colic or complications such as acute cholecystitis or gallstone pancreatitis. Recent studies have allowed for a better understanding of the risk of symptoms or complications in patients with gallstones. In addition, newer data suggest an association of gallstones with overall mortality, cardiovascular disease, gastrointestinal cancers, and non-alcoholic fatty liver disease. Knowledge of appropriate indications and timing of cholecystectomy, particularly for mild biliary pancreatitis, has gradually accumulated. Lastly, there are exciting possibilities for novel agents to treat or prevent cholesterol stone disease. This review covers new advances in our understanding of the natural history, clinical associations, and management of gallstone disease.

Gallstone Disease and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Observational Studies

OBJECTIVES

Gallstone disease shares certain risk factors with cardiovascular disease, particularly metabolic risk factors. Patients with gallstone disease may be at increased risk of cardiovascular disease. Several recent studies exploring the effect of gallstone disease on cardiovascular disease outcomes demonstrated inconsistent results.

DESIGN

We conducted a systematic review and meta-analysis of cohort, case-control, and cross-sectional studies that compared the risk of developing cardiovascular disease events in patients with gallstone disease versus non-gallstone disease controls. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the pooled hazard ratio, odd ratio, and 95% confidence interval.

RESULTS

Data were extracted from six studies involving 176,734 cases and 803,714 controls. The pooled hazard ratio of cardiovascular events in patients with gallstone disease was 1.28 (95% confidence interval: 1.23-1.33, I² = 42%). The pooled odd ratio of cardiovascular events in patients with gallstone disease was 1.82 (95% confidence interval: 1.47-2.24, I² = 68%).

CONCLUSIONS

Our study demonstrated a statistically significant increase in the risk of cardiovascular disease among patients with gallstone disease.

Fructose and Cardiometabolic Health: What the Evidence From Sugar-Sweetened Beverages Tells Us

Recent attention has focused on fructose as having a unique role in the pathogenesis of cardiometabolic diseases. However, because we rarely consume fructose in isolation, the major source of fructose in the diet comes from fructose-containing sugars, sucrose and high fructose corn syrup, in sugar-sweetened beverages and foods. Intake of sugar-sweetened beverages has been consistently linked to increased risk of obesity, type 2 diabetes, and cardiovascular disease in various populations. Putative underlying mechanisms include incomplete compensation for liquid calories, adverse glycemic effects, and increased hepatic metabolism of fructose leading to de novo lipogenesis, production of uric acid, and accumulation of visceral and ectopic fat. In this review we summarize the epidemiological and clinical trial evidence evaluating added sugars, especially sugar-sweetened beverages, and the risk of obesity, diabetes, and cardiovascular disease and address potential biological mechanisms with an emphasis on fructose physiology. We also discuss strategies to reduce intake of fructose-containing beverages.

Gallstone Disease and the Risk of Ischemic Heart Disease

OBJECTIVE

Gallstone disease (GSD) is related to multiple cardiovascular risk factors; the present study was to prospectively examine the association between GSD and ischemic heart disease (IHD).

APPROACH AND RESULTS

We examined the association of GSD with IHD among 199 292 men and 288 081 women aged 30-79 years in the China Kadoorie Biobank study. Participants with cancer, heart disease, and stroke at baseline were excluded. Cox proportional hazards regression model was used to estimate the association of GSD with IHD. The prevalence of self-reported GSD was 3.7% in men and 7.3% in women at baseline. During 3 431 124 person-years of follow-up between 2004 and 2013 (median, 7.2 years), we documented 10 245 incident IHD cases in men and 14 714 in women. As compared with men without GSD at baseline, the multivariate-adjusted hazard ratio for IHD was 1.11 (95% confidence interval, 1.02-1.22) for men with GSD; the respective hazard ratio was 1.27 (95% confidence interval, 1.20-1.34) in women and 1.23 (95% confidence interval, 1.17-1.28) in the whole cohort. The sex difference in IHD risk associated with GSD was statistically significant (P=0.009 for interaction with sex). In addition, we found that the association between GSD and IHD was stronger in nonhypertensive than in hypertensive women (P<0.001 for interaction).

CONCLUSIONS

In this large prospective study, the presence of GSD was associated with an increased risk of incident IHD, independent of other risk factors of cardiovascular disease. Our findings suggest novel prevention strategy to mitigate heart disease through improvement of gastrointestinal health.